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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408984
Report Date: 07/18/2019
Date Signed: 07/18/2019 04:12:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:NEE, HELENFACILITY NUMBER:
434408984
ADMINISTRATOR:NEE, HELENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 972-4890
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 1DATE:
07/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Nee, HelenTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Araceli Almaraz conducted an annual random inspection. LPA met with Licensee, Nee, Helen and explained the nature of today's inspection. Present during the inspection was the licensee. There was one child (toddler) present. The hours of operation of the day-care are 7 Am to 6 PM, Monday through Friday. There are three adults residing in the home; Licensee, spouse Nee, Hongkui and adult son Nee, Andrew. Licensee has CPR and First Aid, which has an expiration date of 05/2021. LPA reviewed one children's file and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA observed that the Licensee has record of MMR & Tdap vaccinations as well as for the flu vaccine. LPA observed a working smoke/carbon monoxide detector and 3A40BC fire extinguisher. Licensee states there is a swimming pool in the backyard. LPA observed there is a pool cover on pool, in addition there is a gate to prevent direct access. LPA observed the pool cover is in compliance with regulation 102417(g)(5)(a)Operation of a Family Child Care Home: Pool covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and locked while the pool is not in use. LPA observed licensee stand on pool cover and it supported the full weight.

LPA did not observe any heaters in the home. LPA observed a fenced fireplace. LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; five bedrooms and two bathrooms. Off limit areas outside the home are as follows: The left side of the backyard where the pool is, this area is fenced as an additional precaution. The front yard is safety compliant and the entire backyard is fenced. Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPA observed a current roster, a current fire disaster/earthquake drills last log 04/19/2019. Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has day care insurance. Licensee has not completed Mandated Reporter Training, licensee is waiting for Mandarin edition to be available. Licensee understands training is to be completed every two years once available.

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SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: NEE, HELEN
FACILITY NUMBER: 434408984
VISIT DATE: 07/18/2019
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.



A review of staff records on 07/18/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There are no deficiencies during today’s inspection.

LPA conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

NOTICE OF SITE INSPECTION ISSUES AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS

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SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2